AB0485 TRIGGERS OF DISEASE FLARES IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: S. Skhiri, A. Baya Chatti, S. Toujani, Z. Meddeb, C. Abdelkefi, A. El Ouni, S. Hamzeoui, T. Larbi, K. Bouslama
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) is a chronic relapsing-remitting disease characterized by a clinical heterogeneity, an unpredictable pattern and a capricious course. Despite great advances in diagnosis and treatment strategies, lupus flares of varying severity still occur, leading to an increased risk of organs damages and a poorer prognosis. Preventing flares, achieving and maintaining remission represent the main objective in SLE management and remain a major challenge for practitioners. Objectives Our study aimed to describe lupus flare-ups and identify its triggering factors, in a cohort of patients with active SLE, in order to optimize disease control. Methods We conducted a retrospective study including patients with SLE followed for a period of 20 years. SLE diagnosis was retained according to the American college of Rheumatology classification criteria (ACR) of 1997 and/or to the SLICC 2012 criteria. A lupus flare was defined by the occurrence of new or worsening lupus manifestation, justifying treatment intensification. We evaluated potential flare triggers, disease activity at each outbreak according to the SLEDAI-2K score and flare types. Patients considered at full clinical remission or at low disease activity state (SLEDAI ≤ 3 in patients treated with antimalarials drugs / SLEDAI ≤ 4 in patients treated with a low glucocorticoids dose &lt;7.5 mg of Prednisone per day ± immunosuppressant) during the study period were excluded (31/102; 30.4% of patients). Results A total of 72 patients, with a mean age at SLE diagnosis of 31 years [11-66] and a gender ratio (F/M) of 8:1, were enrolled. During follow-up, 186 flares occurred. The average number of flares per patient was 3 [1-13]. The mean SLEDAI score during flare-ups was 8 [6-21]. At least one triggering factor was found in 62.9% of flares. The identified triggers for lupus flares were medication nonadherence in 54.7% of cases (discontinuation of antimalarial drugs and corticosteroid therapy in 38.46% and 16.2% of cases, respectively), an intercurrent infection in 30.7% of cases, a hormonal factor in 11.96% and inadequate photoprotection and/or excessive sun exposure in 8.5% of flares. Elsewhere, lupus flare-ups could be explained by therapeutic inertia or corticosteroid dependence (mean dose of 12.5mg per day) in 3.4% and 13.7 % of cases, respectively. Frequencies of general symptoms, cutaneous and haematological flare-ups were higher in relapses with objectified triggering factors (26.5% vs 8.7%, p=0.02; 40.2% vs 26.1%, p=0.036; 32.5% vs 14.5%, p=0.005). In contrast, renal flare-ups were more frequent in the group of flares in which no triggering factors were identified (21.4% vs 33.3%, p=0,005). Disease activity was comparable in both groups. The average follow-up time was 8 years [1-26]. Conclusion In our cohort, an avoidable trigger, dominated by poor medication compliance and infections, preceded more than one out of two lupus flares. Formalized and organized therapeutic education should be one of the pillars of SLE management. Disclosure of Interests None declared